Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism Flashcards Preview

Pathophysiology > Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism > Flashcards

Flashcards in Final: Ch 32 Disorders of Endocrine Control of Growth & Metabolism Deck (93):
1

anterior pituitary produces which hormones

GH

TSH, FSH

ACTH

LH

prolactin

2

posterior pituitary produces what hormones

ADH

Oxytocin

3

definition of hypo function

decreased gland function for any reason

congenital absence of gland or lack of enzyme

destruction by low blood flow, infection, inflammation, autoimmune rxn

aging decreases function, hormone receptors down-regulated

4

definition of hyper function

increased hormone production for any reason

overstimulation or tumor

5

primary disorders

in the gland itself

6

secondary disorders

result from altered stimulation of a normal gland

7

tertiary disorders

result from destruction of the hypothalamus

8

pituitary tumors are mostly ______

adenomas

9

symptoms of pituitary tumors depend on...

hormone secreted

can produce headache, n/v, visual disturbance

10

carcinoma of pituitary

uncommon

may need surgical removal

11

hypo pituitarism

decreased secretion of pituitary hormones

seen when 3/4 of anterior pituitary destroyed

12

symptoms of hypo pituitarism

weakness, fatigue

low appetite, sexual function

cold intolerance

13

sequence of loss for hypo pituitarism

look for the ademona (GH, LH, FSH, TSH, ACTH)

ACTH loss most serious --> adrenal insufficiency

14

Dx, Rx of hypo pituitarism

test for pituitary hormone levels

treat cause

replace hormones

15

assessment of hypothalmic-pituitary function

blood tests: ACTH, cortisol, PL, TSH, T3/4, FSH, LH, GH,

plasma/urine osmolarity

MRI of hypothalamus/ant pit

16

growth hormone (somatotropin) release is controlled by

GHRH and GHIH (somatostatin)

17

growth hormone is stimulated by

low BS

high aa

stress

exercise

18

what does growth hormone stimulate

growth via IGF-1 by upping protein synthesis

cartilage growth

bone growth

endocrine organ growth

muscle growth

19

growth hormone has anti-____ effects

insulin

ups lipolysis

lowers glucose use

20

definition of short stature in children

hight less than 3rd percentile or slow linear growth

21

treatment of short stature in children

rule out endocrine causes

test GH, IGF-1 levels

use bone x-ray to assess bone age

MRI or CT of hypothalamus/pituitary

22

idiopathic short stature

genetic/familial

correct patent's height for sex and average

are the kids normally proportioned?

23

constitutional short stature

common in boys > girls

growth delay

late development/puberty/growth spurt

24

GH deficiency in children is from?

from lack of GHRH or from pituitary lack of GH (give GH)

inability to produce GH receptors (give IGF-1)

25

GH deficiency in adults

can be present from childhood or develop in adulthood

increases central obesity and atherosclerosis risk

26

GH production ____ with age

falls

marketed as the fountain of youth

27

Dx Rx of GH deficiency in adults

Dx: stimulation test with insulin or L-dopa

Rx: GH replacement, higher lean body bass, bone density, GF

28

tall stature in children

constitutional tall stature: tall vs. peers

Marfan's

XYY

excessive sex hormones or GH

29

GH excess in children causes

gigantism

high GH --> high IGF prior to closure of epiphyseal plates

30

causes of excessive GH in adults

GH secreting pituitary adenoma

31

symptoms of excessive GH in adults

acromegaly - soft tissue and flat bone growth

deep voice, and malocclusion

insulin resistance

headaches

visual disturbances

32

Rx of excessive GH in adults

correct metabolic abnormality

remove tumor

GH analogs stimulate neg feedback inhibition of GH

33

precocious puberty

early activation of hypothalmic-pituitary-gonad-axis

early development of secondary sex characteristics

idiopathic or from abnormality

treatment depends on cause

34

anatomy of thyroid

gland located inferior and anterior to larynx

contains colloid filled follicles

colloid contains thyroglobulin

35

in the thyroid, iodine is captured by

Na+/I- co-transporter

active process

stimulated by TSH

36

in the thyroid, iodine is moved into the colloid by ______

pendrin

active process

37

iodine is oxidized and added to ______

tyrosine --> T3, T4

uses thyroid peroxidase

38

T3/T4 added to __ and stored in _____

TG, colloid

39

what causes release of T3/T4

TSH

T4 = 90% of released hormone

travels in plasma bound to TBG/other proteins

40

control of thyroid hormone secretion

stress and cold trigger TRH release from hypothalamus

TRH triggers TSH release from ant. pit.

TSH triggers T3/T4 production and release from TG

negative feedback inhibition of TRH/TSH

41

effect of thyroid hormone on metabolic rate

increases for all tissues (glucose, fat, protein use increases)

normal levels of T3/T4 needed for protein synthesis

42

in hyperthyroidism, muscle breakdown _____

increases --> fatigue

fat mobilization and use increases

43

in hypothyroidism what happens to serum cholesterol

increases

44

effect of thyroid hormone on the cardiovascular system

CO, HR, contractility, blood volume, O2 use all increase

45

effect of thyroid hormone on GI

motility and secretion increase

diarrhea in hyperthyroidism

46

effect of thyroid hormone on neuromuscular system

increases muscle tone --> tremors in hyperthyroid

needed for infant brain development

more CNS activity --> nervousness in hyperthyroid

47

congenital hypothyroidism causes

lack of gland

lack of ability to synthesize T3/T4 or TSH

48

symptoms of congenital hypothyroidism

slow brain development/overall development

jaundice

respiratory/feeding difficulties from large tongue

sluggishness/lack of interest

umbilical hernia

49

Dx, Rx of congenital hypothyroidism

Dx: screening for T4 and TSH

Rx: hormone replacement begun by 6 wks of age = normal intelligence

50

acquired hypothyroidism (myxedema) in children or adults

usually primary - hashimoto's

can be from surgery, iodine deficiency, or too much iodine

51

symptoms of acquired hypothyroidism

hypo-metabolic state

weight gain

fatigue

cold intolerance

fluid accumulation

low HR

52

Dx of acquired hypothyroidism

T3/T4, TSH testing

anti-thyroid Ab test (anti-TPO)

53

Rx of acquired hypothyroidism

synthetic T3/T4

54

myxedematous coma

potentially fatal complication of severe hypothyroidism

coma, hypothermia, hypoventilation, cardiac collapse, electrolyte imbalance

55

precipitating factors of myxedematous coma

cold

sedatives (low drug metabolism in hypothyroidism)

56

Rx of myxedematous coma

manage fluid and electrolyte imbalances

treat hypercapnea/hypoxia

don't re-warm b/c cardiovascular collapse

57

2 causes of hyperthyroidism

Grave's disease (autoimmune, most common)

adenoma

58

symptoms of hyperthyroidism

hyper-metabolic state

nervousness, irritability, tachycardia

weight loss

exopthalamus (eye bulge)

heat intolerance

59

Rx of hyperthyroidism

remove gland w/ surgery or radioactive iodine

anti-thyroid drugs block production of T3/T4 and T4 -> T3

beta-blockers reduce sympathetic symptoms

60

grave's disease (hyperthyroid state)

most common in 20-40 yoa

autoimmune disease - Ab stimulate TSHr

cytokines activate fibroblasts behind orbit --> exophthalmos

61

thyroid storm

life threatening crisis of thyrotoxicosis (hyperthyroidism)

caused by disease stress (infection, ketoacidosis)

large spike in thyroid hormone

62

symptoms of thyroid storm

high fever

tachycardia

angina

HF

63

treatment of thyroid storm

cool down

fluids

beta-blockers

anti-thyroid drugs

steroids for stress

64

adrenal cortex secretes

steroids

aldosterone

cortisol

testosterone

65

adrenal medulla secretes

catecholamines

66

biosynthesis of cortical steroids

made from cholesterol using enzymes

67

cortisol and testosterone are secreted to ____

ACTH

68

aldosterone regulated by which system

RAA

69

adrenal sex hormones (T) has little to no impact on _____

males

body hair growth in females?

70

aldosterone does what

act on kidney to retain Na and excrete K

71

hypothalamus is stimulated by multiple ____ factors

stress

dimural variation peak at 6-8 am

72

metabolic effects of cortisol

gluconeogenesis

protein catabolism

lipid mobilization

higher blood sugar

73

psychological effects of cortisol (pharma dose)

psychosis

behavioral change

74

anti-inflammatory effects of cortisol pharma dose

inhibit prostaglandin synthesis

75

immune effect of cortisol pharma dose

lower cell and humoral immunity

76

adrenal suppression

long-term cortisol therapy suppresses adrenal function

recovery takes months

77

tests for adrenal function

cortisol

aldosterone

ACTH

78

congenital adrenal hyperplasia

recessive enzyme deficiency - low cortisol high ACTH and androgens

21alpha-hydroxylase most common, 11beta-hydroxylase rare

decreased aldosterone

79

females congenital adrenal hyperplasia

virilization of genitalia

80

Rx of congenital adrenal hyperplasia

replace missing hormones

surgical reconstruction of genitalia

81

primary adrenal cortical insufficiency (addison's disease)

autoimmune destruction of entire adrenal cortex

can be from cancer or infection

causes hyperpigmentation and requires lifelong hormone replacement

82

secondary adrenal cortical insufficiency

caused by pit defect or cortical suppression by exogenous steroids

aldosterone normal

no increased ACTH so no hyperpigmentation

83

acute adrenal crisis

happens when a person w/ cortical insufficiency is stressed (infection or surgery)

replace salt, sugar, and steroids

support any failing functions

treat cause

84

glucocorticoid excess (cushing's syndrome) 4 causes

overproduction of ACTH by pit tumor

adrenal tumor

non-pit tumor secreting ACTH

long-term cortisol therapy

85

symptoms of cushing's

fat pads (buffalo hump)

muscle atrophy

Na retention --> HTN

K+ loss

diabetes

86

Dx of cushing's

tert urine for 24 hr cortisol excretion

test blood for ACTH to determine cause

87

Rx of cushing's

surgery

irradiation

medication

88

Addison's produces low levels of _______ but high levels of ____

Cortisol, ACTH

89

Does Hashimoto's (hypothyroidism) cause high trophic hormone levels?

Yes

90

Does grave's (hyperthyroidism) cause lowered trophic hormone levels?

Yes

91

Does secondary adrenal cortex insufficiency cause lowered cortisol and ACTH?

Yes

92

Does acromegaly mean high GH and IGF-1?

Yes

93

Do defects in the 21 and 11 hydroxylase genes cause less cortisol and aldosterone, but high testosterone?

Yes